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Historically, the surgical approach was the only option for those suffering from varicose veins with lower extremity edema, (swelling), and pain. With advances in modern technology, minimally invasive procedures, such as Radiofrequency ablation (RFA) and Endovenous laser therapy (EVLT), are alternative options in the treatment of varicose veins.
Varicose Veins Overview
Varicose veins are the result of venous insufficiency and hypertension and when left untreated usually progress to more severe symptoms. Veins have one-way valves, preventing blood from flowing backward to your feet and legs. When these valves and their surrounding structures become damaged, this system is unable to function correctly. Instead of blood circulating back towards your heart, blood pools in your lower extremities. And to compensate for the extra blood volume, your veins dilate and enlarge. Over time, changes occur to the architecture within the vessel wall, leading to rising pressures and causing venous hypertension. Together, venous insufficiency and hypertension create varicose veins.
Radiofrequency Ablation Therapy for Varicose Veins
Though compression stockings alleviate varicose veins symptoms, they do not treat the underlying pathology. Ablation therapies, like RFA and EVLT, have replaced vein surgery as a minimally-invasive technique to eliminate venous incompetence.
Ablation therapies are cost-effective and have lower complication rates than undergoing surgery. Also, the procedures are commonly well tolerated by patients, improving their quality of life. Clinical trials have shown positive results at 4-5 years, and newer studies have shown long-term benefits at ten years as well.
How Does RFA Work?
All ablation therapies work by destroying the venous tissues by either using a form of thermal energy or chemical irritant. RFA uses a special catheter to deliver infrared energy directly into the vessel wall. The catheter is held in place while energy heats the catheter tip to a specific temperature, generally 120°C, causing the vessel to shrink. Your physician inserts the catheter, and while a system monitors the heat, your doctor slowly withdraws the catheter along the course of the vein, and the RFA destroys the vessel.
Duplex Ultrasonography Confirms Venous Reflux
Your physician uses a duplex ultrasound to confirm and map all areas of venous reflux, tracing the path and marking the fields in some way on your skin. After selecting an entry point above or below your knee, your doctor prepares your leg for the procedure. Local anesthesia numbs the area, and with the help of duplex ultrasound, your doctor punctures the vessel with a needle, inserting the catheter. Don’t worry; the puncture site is no more significant than what a nurse would use when placing an intravenous catheter for fluids! Because RFA uses high temperatures, your physician injects a particular solution, tumescent anesthesia, to protect your skin from the heat.
Compression Stockings Post-Procedure
Wearing your compression stockings after receiving any ablation therapy is exceptionally vital for treatment success. Compression hosiery reduces post-procedure bruising and tenderness, but most importantly: decreases the risk of developing a blood clot, a deep venous thrombosis, in both the treated and untreated leg.
If you experience the following symptoms after receiving an ablation procedure, contact your doctor immediately:
Swelling in your feet or legs
Pain in your feet or legs
Pain unrelieved by Ibuprofen
Redness along the treated area
With any medical procedure, complications can happen, even if the treatment was technically successful. Minimally invasive procedures, like RFA, generally have less reported complications than vein surgery. Nerve injury, such as numbness and odd sensations, do occur, though usually resolve over time. Skin burns can also happen and are the reason behind why doctors use tumescent anesthesia: to provide a buffer between your skin and the infrared energy.
The most significant concern with any medical procedure, especially with venous treatments, is always the development of deep venous thrombosis. Early ambulation and wearing your compression stockings, as your doctor recommends, are extremely important to your well-being. Both improve your venous circulation, helping to prevent blood clots from forming. The best thing you can do after any procedure: get up and move!
Take a Vein Quiz
If you have varicose veins and are experiencing leg pain, take a vein quiz and find out your vein score. You may find that you qualify for ablation procedures, like Radiofrequency ablation, to treat your varicose veins. Talk with your doctor today and ask for a referral to see a Vein Specialist. These are doctors that specialize in treating venous and lymphatic conditions. They can talk with you about what are the best treatment options available for you. So, find out your vein score today! Your veins will thank you!
Medically reviewed by Dr. Susanne Woloson on 5-01-2020.
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